Role of the Protective Ileostomy in Non Traumatic Ileal Perforation and its Outcome in KR Hospital Mysore

Abstract

Background And Objectives Typhoid fever still remains one of the leading causes of ileal perforation and the patients usually present late with toxic features, feculent peritonitis with multiple ileal perforation and a inflamed friable bowel, the earlier approach of only primary closure of perforation or resection anastomosis usually carries with it high morbidity and mortality with serious catastrophic complications like fecal fistula. This study is focused on evaluating a shift in favor of defunctioning protective ileostomy following primary closure . Methods This is a prospective observational study of 30 patients admitted to K.R. Hospital attached to Mysore Medical College and Research Institute, Mysore with ileal perforation (diagnosed per-operatively) during the period from may 2022 to June 2024. All the 30 patients of ileal perforation were divided into two groups on consecutive sampling basis: Group A (primary repair with protective ileostomy and Group B (only primary repair). Results The age of patients ranged from 18 to 60 years, with 60% of patients being in the age group of 20-40 years; with a male preponderance. An increased rate of postoperative complication was seen in Group B when compared to Group A with 36% having wound dehiscence, 60% wound infection and 40% ended up in fecal fistula formation. Seven out of 15 patients in Group B developed fecal fistula, in which 5 succumbed to death. None of the patients in Group A developed fecal fistula. Mortality was thrice higher in Group B when compared to Group A. It was observed that hospital stay was longer for group B, than compared to group